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Peripartum cardiomyopathy is a leading cause of death among pregnant women in developing countries. Could the development of a biomarker screening test soon put a stop to that?

Sudden and potentially preventable deaths are always tragic, but a special dimension of grief is added when a pregnant woman passes away. In developing countries, peripartum cardiomyopathy is among the leading causes of death in pregnant women in their last month of gestation. 

Peripartum cardiomyopathy (PPCM) is a heart muscle condition that affects women in their final month of pregnancy and up to five months postpartum. It prevents the heart from pumping blood around the body effectively and can lead to numerous life-threatening complications, including sudden cardiac death. 

In Haiti, South Africa and Egypt, PPCM is the leading cause of death in pregnant women and brand new mothers, but the condition can strike any pregnant woman or new mother — regardless of her health, age, or ethnic background. Around one in 1300 to 4000 women who gave birth to live babies are affected by PPCM in the United States, data show, while that figure rises to one in 1000 in South African Bantus and one in 300 in Haiti. 

Diagnosing PPCM in a timely manner is the key to reducing deaths and helping affected women make a full recovery. That is why the recent discovery of a biomarker  for PPCM is such good news. 

PPCM Biomarker Test Developed

"We have found a way to detect rather quickly whether the woman has PPCM and to treat it quickly and efficiently," Professor Alexandre Mebazaa from the Hopital Lariboisiere in Paris, France said. Professor Mebazza was the co-author of a new study, the results of which were presented at Heart Failure 2014, an event that opened the World Congress on Acute Heart Failure on May 17.

This is very important, because PPCM occurs in otherwise healthy women and its symptoms — edema, breathing difficulties and heart palpitations — are hard to differentiate from normal late pregnancy symptoms. 

"For pregnant women there are two major causes of death: massive hemorrhage and PPCM, and it is a very sad situation because a time of great happiness turns to great sorrow and the new baby and the father are left alone," Professor Alexandre Mebazaa said. 

How did the team come up with the the biomarker screening test? They knew that  angiogenesis and relaxin-2 pathways are altered in women who have PPCM, and speculated that the biomarkers ratio of the pathways' placental growth factors/sFlt-1 and relaxin-2 could be used to develop a test that differentiates PPCM from other conditions or normal pregnancy symptoms

The researchers looked at plasma from 77 women with PPCM, as well as plasma from 75 healthy peripartum women, 25 breastfeeding mothers, and 65 acute heart failure patients who were not pregnant. They tested for levels of cardiovascular (NT-proBNP), anti- (sFlt-1) and angiogenic [Placental (PlGF) or vascular endothelial (VEGF)] . The women who had PPCM were shown to have much higher levels of NT-proBNP. Meanwhile, they had lower levels of plasma relaxin-2, and the sFlt-1/PlGF ratio and sFlt-1/VEGF ratio were statistically lower.

In lay person's terms, that simply means that scientists are on the way to developing a very effective screening test that could save a lot of lives in the future.

The next step is a large cohort study, and after that a test for PPCM could become part of the usual battery of prenatal screening tests. 

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